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Thursday, June 6, 2013

PEPFAR budget cuts cause anxiety

"The world won't end AIDS without PEPFAR"
ADDIS ABABA, 6 June 2013 (IRIN) - Ten years ago, a shipping container
was converted into Ethiopia’s first HIV treatment centre, in Addis
Ababa, the capital. Created in response to a dramatic rise in new HIV
infections and AIDS -related deaths, the centre offered the only hope
for HIV-positive Ethiopians, who had to pay to access the
life-prolonging antiretroviral therapy (ART).

When US Global AIDS Coordinator Ambassador Eric Goosby
joined other US and Ethiopian officials at the centre on a recent trip,
they found a state-of-the-art facility, where thousands of clients
receive free, comprehensive HIV treatment. The centre, a wing at the
Empress Zewditu Memorial Hospital, has just added an outpatient annex.

“At least 350 clients will be seen daily in this new facility, some of
whom have not been able to receive the services they need and deserve
elsewhere. I particularly applaud Zewditu for its tremendous effort to
build the first site in Ethiopia that offers counselling and testing
services for the deaf and blind,” Goosby said at the inauguration
ceremony.

The centre is now one of 900 sites across the country where over 290,000
people are receiving ART. The new centre, like thousands across Africa,
was funded by the US government-run President’s Emergency Plan for AIDS
Relief (PEPFAR).

Established in 2003, PEPFAR was the product of a rare bipartisan deal
between former US president George W. Bush and lawmakers spearheaded by
the Congressional Black Caucus. It was first a commitment of US$15
billion in funding to fight the global HIV/AIDS pandemic; at the launch
of the plan, only 50,000 Africans were accessing ART, according to Eric
Goosby who heads PEPFAR.

In 2012, an estimated 8 million people were receiving treatment in low- and middle-income countries - of which PEPFAR
directly supported 5.1 million. This was a 20-fold increase in
treatment coverage since PEPFAR was created in 2003. In 2012 alone, the
emergency plan helped carry out 46 million HIV tests, preventing 230,000
babies from being born HIV-positive, Goosby said in an interview with
IRIN.

Funding cuts versus AIDS-free generation

But experts are concerned that consistent budget cuts in PEPFAR funding
could make reaching the goal of an HIV-free generation difficult, if not
impossible.

Chris Collins, a vice president and director of public policy at the Foundation for AIDS Research (amfAR), argues that despite impressive gains made in the AIDS response now is not the time for funding cuts.

"Funding for PEPFAR has fallen 12 percent since 2010 in the State
Department HIV bilateral budget line. Last week, the White House
proposed an additional $50 million cut for 2014. When the mandated
sequestration cut is taken into account, the programme is now at its
lowest funding level since 2007," Collins noted in an April editorial.

“The honest truth is that the world won't end AIDS without PEPFAR. Some
will say: judge PEPFAR on its outcomes, not its funding. But when
PEPFAR's own Blueprint calls for rapid scale-up of effective services in
order to show tangible gains, it's hard to understand why now is the
time to cut back,” Collins argued.

But Goosby explained the cuts are being made for three reasons. The
first is because they are “getting better and smarter” in service
delivery, such as procuring and shipping commodities like condoms and
test kits at cheaper costs and favouring less expensive generic drugs
over pricey brands.

“We also started a dialogue (this… was an attempt to try to make these
services sustainable, not just dependent on one funder) with governments
around what their contribution was now to these services and what they
could be. And governments all heard this and [began] to pour… their own
money into the service pot,” he told IRIN. “So, again, it would be
additives, so we can build on what we have already started... with a
donor-start but it is a government finish.”

The US is also looking to more cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria
to raise funds to pay for the HIV prevention and treatment programmes,
according to Goosby, who says the US donates a third of the money that
goes to the Global Fund.

“So we think of it as a shared responsibility... We see our ethical
obligation to the patients that are using these services... We will not
renege on that. But we also feel that in order to make sure these
services continue, we need to diversify the fund portfolio so others are
contributing.”

Chipping in

But whether poorer countries in the region will be able to take over the ongoing programmes is a concern for many.

According to the African Union commission, a number of countries have
begun to implement innovative AIDS financing measures intended to reduce
dependence on external funders such as PEPFAR.

“Zimbabwe and Kenya now earmark a portion of domestic tax revenues for
an AIDS Trust Fund, while countries such as Benin, Congo, Madagascar,
Mali, Mauritius, Niger, Rwanda and Uganda have established special HIV
levies on mobile phone usage or airfares,” said the commission in a
statement issued on May 26. “Taking a different approach, South Africa
reduced its spending on antiretroviral medications by 53 percent by
reforming its tender process to increase competition among suppliers.”

PEPFAR's Goosby agrees it is not yet time to scale back the fight
against HIV/AIDS. “If we pull back on what we are doing for HIV, it will
come right back, without any doubt. We see that in just about every
infectious disease, but HIV is notorious for this. So keeping this going
becomes the challenge. That's why we want to emphasize the shared
responsibility."
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